Healthcare Provider Details

I. General information

NPI: 1568956209
Provider Name (Legal Business Name): CAROLINA HOMELESS VETERANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2018
Last Update Date: 06/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 MCLEOD AVE
CHARLESTON SC
29412-2922
US

IV. Provider business mailing address

1707 MCLEOD AVE
CHARLESTON SC
29412-2922
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-8780
  • Fax: 843-769-5112
Mailing address:
  • Phone: 843-795-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number0425
License Number StateSC

VIII. Authorized Official

Name: MARTHA ALSTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-795-8780